Michigan child care centers, Head Start and Early Head Start programs and schools use this four-page appraisal so they can meet a child's physical and developmental needs. Clinicians see it at enrollment physicals; it collects screenings, exam findings, exact immunization dates and recommendations such as seating or activity restrictions, with an optional dental section.
The parent completes the personal details and Section I health history. The examining physician, nurse practitioner or physician assistant completes Sections II to IV; Section III immunizations may be transcribed from the immunization certificate, and a dentist, dental therapist or hygienist may complete Section V.
Download the current version from the source each time; forms change without notice.
Health Appraisal
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The form quotes Public Act 368 of 1978: any child enrolling in a Michigan school for the first time must be adequately immunized, vision tested and hearing tested. Medical, religious and other waivers are allowed if properly prepared, signed and delivered to school administrators.
The footer says child care licensing needs the physical exam, restrictions and immunizations. Sections II and IV are marked required for child care and Head Start, and Early On uses the form for hearing and vision status, diagnosis and health status.
A note in Section II says all children in Medicaid need blood lead testing at 1 and 2 years of age, or once between 3 and 6 years if not previously tested, and other children should be tested at those ages if they live where lead risk is high.